Rate and predictors of biologic initiation in patients with severe asthma: a retrospective cohort study.

Authors

John J Oppenheimer, Tom Corbridge, Alexandra Stach-Klysh, Guillaume Germain, Sean D MacKnight, Julien Boudreau, François Laliberté, Arijita Deb

Published in

Therapeutic advances in respiratory disease. Volume 20. Pages 17534666261459926. Epub Aug 10, 2026.

Abstract

Biologic therapy uptake for poorly controlled severe asthma is suboptimal despite guideline recommendations.
To evaluate real-world biologic initiation trends and predictors among patients with severe uncontrolled asthma (SUA) and SUA with eosinophilic phenotype (SUA-EP).
A retrospective real-world cohort study that used Komodo Health administrative claims to identify US patients with SUA (controller/rescue medication use and ⩾2 asthma exacerbations in a year) and a subgroup of patients with SUA-EP (blood eosinophil count ⩾150 cells/µL in the year pre- or post-exacerbation).
Biologic initiation trends following first asthma exacerbation were assessed, and factors associated with lack of biologic initiation following second exacerbation (SUA-EP only) were identified using LASSO regression models; odds ratios (OR), 95% confidence intervals (CIs), and p-values were calculated using logistic regression.
Biologic initiation rates following the first exacerbation were low at 12.7% (4360/34,246) and 12.2% (309/2526) of patients with SUA and SUA-EP, respectively; mean time between second exacerbation and initiation was 13.4 and 11.9 months. Predictors of lack of biologic initiation included young age (12-17 years; OR (95% CI) 3.65 (1.69-7.89)), primary care physician specialty at index relative to respiratory specialist (2.89 (2.04-4.10)), and antibiotic use (2.29 (1.44-3.66); all p < 0.05), indicating that younger patients, those managed by primary care and those treated with antibiotics for exacerbations, were less likely to receive biologics. Biologic initiation was more likely among patients with a cumulative systemic corticosteroid dose ⩾500 mg (prednisone equivalent; 0.38 (0.25-0.57)), those using leukotriene modifiers (0.42 (0.28-0.62)) or single-inhaler triple therapy (0.06 (0.01-0.40)), and those with eosinophilic disorders (0.19 (0.07-0.52); all p < 0.05).
Despite eligibility, most patients with SUA and SUA-EP did not receive any biologic; younger age and primary care management were predictors of lack of biologic initiation. This highlights the need for improved specialist referral and biologic uptake.

PMID:
42572493
Bibliographic data and abstract were imported from PubMed on 10 Aug 2026.

Read full publication at:
Please sign in to see all details.

Stats

1-terrible, 9-excellent. How would you rate this publication? Sign in in to submit your rating.

Post a comment

You need to be signed in to post comments. You can sign in here.

Comments

There are no comments yet.